With little sign of federal action to address the needs of the nations uninsured, five states last week made strides toward putting health insurance within reach for millions of Americans.
Comprehensive healthcare reform plans were introduced in both Illinois and Minnesota, while the Washington state Legislature passed a measure that would expand coverage to thousands of uninsured children and the Oklahoma Senate passed a bill that would cover uninsured kids in the state. Meanwhile, Massachusetts landmark universal-coverage law, enacted last year, moved ahead as state officials unveiled a list of private health plans that will become available to uninsured residents later this year.
Momentum is continuing to build on the state level, said Enrique Martinez-Vidal, acting director of State Coverage Initiatives, a group that advises states on expanding insurance coverage. What were seeing are more ... legislators taking matters into their own hands.
Illinois Gov. Rod Blagojevich unveiled more details of a $2.1 billion-a-year healthcare reform plan designed to cover the states 1.4 million uninsured adults within three years. His Illinois Covered initiative builds on another plan that was enacted last year to extend coverage to all children in the state. The plan would expand eligibility for state-subsidized coverage for low-income parents and launch a state insurance pool with comprehensive coverage offered through private insurers for small employers and low- to moderate-income adults, said Abby Ottenhoff, a Blagojevich spokeswoman. Businesses with 25 or fewer employees that cover at least 70% of workers premiums would qualify, according to details at illinoiscovered.com.
Blagojevich also proposed a cap on premiums, based on income, for those earning between 100% and 400% of the federal poverty line. Ottenhoff said coverage would be mandatory after the third year. The $2.1 billion price tagthe programs cost once fully implementedwould be partially covered by a tax on employers that fail to offer coverage, Ottenhoff said.
Meanwhile, every Minnesotan would be required to carry health insurance by 2011 under a universal-coverage bill unveiled in that state by a coalition of legislators and executives with insurers and providers, including Blue Cross and Blue Shield of Minnesota and the Mayo Clinic.
The bill would require insurers to offer basic coverage to all, regardless of health history, and proposes subsidies or tax credits to expand coverage. State revenue and commerce officials would monitor coverage using tax returns, state records and health plan enrollment reported by insurers. Providers and employers would be required to report those without coverage, who would face fines. The bill also calls for pilot projects to test so-called medical homes, which would be patients first point of contact and would coordinate chronic care (See related story, p. 36).
Also last week, a bill that would expand coverage to thousands more children in Washington state landed on the desk of Gov. Christine Gregoire after clearing the House. The Senate passed the bill earlier this session and Gregoire has said she would sign it. Roughly 600,000 Washingtoniansincluding 73,000 childrenare uninsured, more than 9% of the states population. Lawmakers added enough money to expand state health insurance to about 10,000 children last session. The measure, passed last week, would extend coverage to an additional 38,000 kids during the next two years. Supporters said the bill would fulfill the states pledge to have all children covered by 2010, and it dovetails with a separate bill introduced last month by Gregoire and Democratic lawmakers seeking universal coverage by 2012.
In Oklahoma, state senators voted 28-14 to pass the All Kids Act, which could provide health coverage to as many as 42,000 children, according to the Associated Press. The bill now goes to the Oklahoma House. If passed, the threshold for Medicaid coverage would be raised to 300% of the federal poverty level, meaning kids whose families earn $60,000 could get coverage. Currently that threshold is $37,000.
A critical component of Massachusetts existing plan fell into place last week when state officials established a list of private health plans that will be offered under the initiative, which requires all residents to have insurance by July 1 or face tax penalties. The plans are intended for the 160,000 to 200,000 residents who are uninsured but earn too much to qualify for state-subsidized coverage.
The board of directors for the Commonwealth Health Insurance Connector Authority approved an array of comprehensive coverage plan options offered by seven insurers. Average monthly premiums for plans that include prescription drug coverage range from $175 to $288, while annual deductibles range from zero to $2,000. The board said the approved rates were a major improvement from insurers initial round of bids, which in January came in averaging $380 a month.
To many observers, the buzz of activity in so many state legislatures is a clear signal that frustrated governors and local lawmakers are losing faith in the federal governments ability to solve the uninsured problem (Jan. 15, p. 6). As the ranks of the uninsured continue to grow increasing by nearly 7 million Americans since the turn of the centurystate lawmakers have apparently concluded that they no longer can afford to wait for Washington.
States feel theyve got no choice, said Susan Sherry, deputy director for healthcare advocacy group Community Catalyst. They know they cant sit around and twiddle their thumbs when citizens need to have these issues addressed.